Healthcare Provider Details

I. General information

NPI: 1093624389
Provider Name (Legal Business Name): NEW TRAILS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 FAIRVIEW OAKS DRIVE SUITE 5
MANDEVILLE LA
70471
US

IV. Provider business mailing address

24232 DAWSON CT
PONCHATOULA LA
70454-4252
US

V. Phone/Fax

Practice location:
  • Phone: 985-205-8848
  • Fax:
Mailing address:
  • Phone: 985-205-8848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL GONZALEZ
Title or Position: OWNER
Credential: LCSW
Phone: 985-205-8848